1. While a home health nurse is making the entry to a service assessment on a home-bound patient, the spouse of the patient asks whether Medicare will cover the patients ventilator therapy and insulin injections. What is the best response by the nurse?
a. Yes, Medicare will cover both the ventilator therapy and the insulin injections.
b. No, Medicare will not cover either of these ongoing therapies.
c. Medicare will cover the ventilator therapy, but it does not cover the insulin injections.
d. Medicare will cover the ongoing insulin therapy, but it does not cover a highly technical skill such as ventilator therapy.
ANS: C
Medicare will cover skilled nursing tasks such as ventilator therapy, but common tasks that can be taught to the family or the patient are not covered.

2. The wife of a patient asks the nurse whether her husband would be considered for placement in a skilled nursing care facility when he is discharged from the general hospital. The patient is incontinent, has mild dementia but is able to ambulate with a walker, and must have help to eat and dress himself. What is the nurses most appropriate response?
a. Yes, your husband would qualify for a skilled care facility because of his inability to feed and dress himself.
b. No, your husbands disabilities would not qualify him for a skilled facility.
c. Yes, your husband qualifies for placement in a skilled care facility because of his dementia.
d. Yes, anyone who is willing to pay can be placed in a skilled nursing facility.
ANS: B
Placement in a skilled nursing facility must be authorized by a physician. A clear need for rehabilitation must be evident, or severe deficits in self-care that have a potential for improvement and require the services of a registered nurse, physical therapist, or speech therapist must exist.

3. A nurse has noted that a newly admitted resident to an extended care facility stays in her room, does not take active part in activities, and leaves the meal table after having eaten very little. The nurse should analyze this relocation response as
a. regression.
b. social withdrawal.
c. depersonalization.
d. passive aggressive.
ANS: B
Social withdrawal is a frequent response to relocation.

4. A nurse clarifies to a new patient in a rehabilitation center what rehabilitation means. What statement made by the patient indicates a correct understanding?
a. I will return to my previous level of functioning.
b. I will be counseled into a new career.
c. I will develop better coping skills to accept his disability.
d. I will attain the greatest degree of independence possible.
ANS: D
The rehabilitation process works to promote independence at whatever level the patient is capable of achieving.

5. A nurse assesses a patient who needs to be reminded to take premeasured oral medications, wash, go to meals, and undress and come to bed at night, but coming and going as he pleases is considered safe for him. What facility placement would be most appropriate for this patient?
a. Skilled care
b. Intermediate care
c. Sheltered housing
d. Domiciliary care
ANS: D
Domiciliary care provides room, board, and supervision, and residents may come and go as they please. Sheltered housing does not provide 24-hour care.

6. A nurse is making a list of the members of the rehabilitation team so the different types of services available to patients may be taught to a group of families. Which lists should be used?
a. Physical therapist, nurse, family members, and personal physician
b. Occupational therapist, dietitian, nurse, and patient
c. Rehabilitation physician, laboratory technician, patient, and family
d. Vocational rehabilitation specialist, patient, and psychiatrist
ANS: A
The rehabilitation team usually consists of all of the choices except the laboratory technician, dietitian, and psychiatrist. (The mental health role is represented by the psychologist.)

7. A nurse explains the level of disability to a patient who was injured in a construction accident that resulted in the loss of both his right arm and right leg. This loss has affected his quality of life and ability to return to previous employment. At what level should the client be classified as being disabled?
a. I
b. II
c. III
d. IV
ANS: B
The patient is limited in the use of his right arm for feeding himself, dressing himself, and driving his car, which are three main activities of daily living. He may be able to work if workplace modifications are made.

8. A nurse explains that in 1990, the Americans with Disabilities Act (ADA) was passed. For which extended services for the disabled persons did this act provide?
a. Covering the costs for the rehabilitation of disabled World War I servicemen by providing job training
b. Extending protection to the disabled in the military sector, such as wheelchair ramps on military bases
c. Extending protection to the disabled in private areas, such as accessibility to public restaurant bathrooms and telephones
d. Affording disabled persons full access to all health care services
ANS: C
The ADA of 1990 extended the previous legislative Acts of 1920, 1935, and 1973. The ADA now covers private sector individuals and public businesses in particular.

9. A frail patient in a long-term care facility asks the nurse if a bath is to be given this morning. What is the best reply by the nurse to encourage independence and give the patient the most flexibility?
a. Based on your room number, you get bathed on Monday, Wednesday, and Friday. Today is Tuesday.
b. If you want to eat breakfast in the dining room with the others, you may sponge yourself off in your bathroom.
c. When your daughter comes this evening, ask her if she can give you a bath.
d. I will bring a basin of water for a sponge off for right now. After breakfast, we will talk about a bath schedule.
ANS: D
The resident should be provided as much flexibility as possible and support for independence.

10. A computer programmer who lost both legs is being retained by his employer, who has made arrangements for a ramp and a special desk to accommodate the patients wheelchair. What is the disability level of the computer programmer?
a. I
b. II
c. III
d. IV
ANS: B
Level II allows for workplace accommodation, which is the desk modification in this case.

11. A partially paralyzed forklift operator is to be retrained by vocational rehabilitation services for less demanding office work. What law provides for this rehabilitation?
a. Vocational Rehabilitation Act of 1920
b. Social Security Act of 1935
c. Rehabilitation Act of 1973
d. Americans with Disabilities Act of 1990
ANS: C
The Rehabilitation Act of 1973 provided a comprehensive approach and expanded resources for public vocational training.

12. The home health care nurse performs all the following actions. Which is the only action that is reimbursable under Medicare payment rules?
a. Observing a spouse cleaning and changing a dressing
b. Taking a frail couple for a walk to provide exercise
c. Watching a patient measure out all medications
d. Teaching a patient to self-administer insulin
ANS: D
Medicare reimburses skilled techniques that are clearly spelled out; these include teaching but not return demonstrationtype actions by patient or family.

13. A patient with multiple sclerosis must be fed, bathed, and dressed. How should the nurse assess this patient?
a. Disabled
b. Disadvantaged
c. Handicapped
d. Impaired
ANS: D
Feeding oneself, dressing, and bathing are activities of daily living. The patient is impaired in this scenario.

14. Which law initially provided for rehabilitation of disabled Americans?
a. Vocational Rehabilitation Act of 1920
b. Social Security Act of 1935
c. Rehabilitation Act of 1973
d. Americans with Disabilities Act of 1990
ANS: A
The U.S. government has passed four pieces of legislation to identify and meet the needs of disabled individuals with each one being more inclusive. The first one was passed in 1920.

15. A client was admitted to a long-term residential care facility. On what should the admitting nurse tell the family the concepts of long-term care are based?
a. Amount of activities the resident can do for herself
b. Maintenance care with an emphasis on incontinence
c. Successful adaptation to the regulations of the home
d. Maintenance of as much function as possible
ANS: D
Maintenance of function and encouraging autonomy and independence are some of the basic concepts of long-term care.

16. A 58-year-old patient with diabetes is recuperating from a broken hip and is concerned about how to pay for rehabilitation. The nurse should inform this patient that funds for rehabilitation are available from which resource?
a. Vocational Rehabilitation Act of 1920
b. Rehabilitation Act of 1973
c. Disabled American Veterans Act of 1990
d. Title V, Health of Crippled Americans 1935
ANS: B
The Rehabilitation Act of 1973 assists in paying for rehabilitation for those who are younger than 65 years of age and who will benefit from vocational rehabilitation through teaching.

17. What is an example of a description of community health nursing?
a. Visiting patients in their homes after hospital discharge to assess their personal health status
b. Asking a nursing assistant (NA) to identify the health services most needed in the patients personal life
c. Meeting with residents of low-income housing to identify their health care needs
d. Developing a hospital-based home health care service
ANS: C
Whereas community-based nursing looks at identified community needs and provides care at all levels of wellness and illness, community health nursing seeks to provide services to groups to modify or create systems of care.

18. Home health nurses have some different nursing activities than those of community health nurses. Which statement best describes the home health nurses activities?
a. Conducting health education classes in a senior citizens common residence building
b. Conducting blood pressure screening on a regular basis at a local mall
c. Visiting and assessing the home care and further teaching needs of a patient who has been recently discharged from the hospital
d. Acting as a nurse consultant to a chronic psychiatric section in a state institution
ANS: C
The home health nurse works with individuals in the home; the other descriptors are community nurse activities.

19. Based on guidelines from the Americans with Disability Act (ADA), which question is an appropriate choice for the director of nurses to ask a nurse with an artificial leg who is applying for a staff position in an extended care facility?
a. How long have you had your prosthesis?
b. How many flights of stairs are you able to climb without assistance?
c. Are you able to lift a load of 45 lb?
d. Has your disability caused you to miss work?
ANS: C
Queries to disabled job applicants can be made relative to specific job functions, but they cannot be asked relative to the severity of the disability or the degree of disability in general.

20. What care skills are safe and appropriate for the licensed practical nurse (LPN) to teach family members in the home health care setting? (Select all that apply.)
a. Insulin injection
b. Sterile dressing changes
c. Venipunctures
d. Periodic Foley catheter insertions
e. Instillation of eye drops
f. Changing dressings on small wounds
ANS: A, E, F
Insulin injections, instillation of eye drops, and small wound dressing changes are safe to teach a nonprofessional caregiver. Sterile dressings, venipunctures, and inserting Foley catheters are considered skilled, and the costs for these are reimbursed by Medicare.

21. The nursing care plan in a long-term care facility calls for the documentation of regressive behavior of a newly admitted 82-year-old resident who has had congestive heart failure and osteoarthritis. Of these behaviors observed by the nurse, which should be documented as regression? (Select all that apply.)
a. Talks nonstop to staff and other residents
b. Wets and soils self several times a day
c. Wakes in the middle of the night and is unable to return to sleep
d. Wears the same clothes day after day
e. Cries frequently for no apparent reason
ANS: B, D, E
Behaviors that are infantile or immature in the absence of dementia are considered regressive. Frequent episodes of crying and inattention to personal hygiene are regressive in nature. Excessive talking and wakefulness may be related to relocation anxiety, but they are not considered regressive.

22. From what do most quality-of-care problems in home health care result? (Select all that apply.)
a. Patients noncompliance
b. Familys reluctance to participate in the care
c. Inadequate documentation
d. Limited funding
e. Defective communication among care team members
ANS: C, E
Inadequate communication and incomplete documentation create most of the quality-of-care problems.

23. An 80-year-old man is newly admitted to a long-term care facility and suddenly becomes incontinent of urine at night. What nursing interventions should be used to help restore self-toileting? (Select all that apply.)
a. Waking the resident every 2 hours and escorting him to the bathroom
b. Leaving a night-light on
c. Discouraging the use of long-legged pajama bottoms
d. Placing a urinal at the bedside
e. Keeping the room uncluttered
ANS: B, C, D, E
Providing light in an uncluttered room, encouraging clothing that does not impede self-toileting, and making the urinal available increase independence and alleviate situations that make self-toileting difficult. Waking a resident not only disturbs his or her rest, but doing so also increases dependency on the staff.

25. A home health nurse, while in the home to change a decubitus dressing, notices that the wound has a musky odor and is weepier than the previous visit, 2 days earlier. Place the following nursing interventions in order of priority from most to least. (Separate the letters with a comma and space: A, B, C, D.)
A. Contact the case manager.
B. Assess the patients entire skin and vital signs and be prepared to describe the wound findings.
C. Cleanse the decubitus area well and redress the wound.
D. Chart the appearance of the decubitus completely.
D. Assess the patients mobility.

ANS:
B, C, E, D, A
The decubitus finding is important to communicate to the case manager but not until the nurse at the bedside has fully assessed the patient, signs and symptoms, vital signs, and other areas of change that need to be promptly communicated. Then the case manager will be able to give directions for further care.

26. What should the home health nurse do when teaching a family member the skill of injecting insulin effectively? Prioritize these nursing interventions for this situation. (Separate the letters with a comma and space: A, B, C, D.)
A. Offer instruction at an appropriate pace.
B. Write down the steps of the procedure.
C. Assess the level of knowledge of the family member.
D. Inquire about the preferred learning style.
E. Evaluate the family members performance.

ANS:
C, B, D, A, E
Effective teaching depends on assessing the level of knowledge, breaking down the skill in steps, offering instruction in the preferred style, pacing the instruction appropriately, and evaluating the performance.